MRI- and CT-derived carotid plaque characteristics and stroke: Insights from the ANTIQUE study

Carotid plaque composition plays a key role in plaque stability and patient risk stratification. Of unstable plaque features, intraplaque hemorrhage (IPH) is considered the main risk factor for stroke development.

We aimed to assess an association between the presence of IPH and other plaque characteristics detectable by computed tomography (CT) or magnetic resonance imaging (MRI) and stroke.

Of all consecutive patients from the ANTIQUE study, 132 (91 males; aged 70.0 [8.6] years) with 59 symptomatic and 157 asymptomatic stable carotid plaques were included in the retrospective analysis of prospectively collected data. Plaques in the vascular territory of ischemic stroke within 90 days were classified as symptomatic and were diagnosed by CT and MRI after symptoms occurred. Plaques without progression and clinical infarction were classified as asymptomatic stable. Univariate and multivariate logistic regression analyses were performed to identify risk factors.

The presence, age, location, and volume of IPH were not related to stroke risk (P >0.05). Patients with symptomatic plaque were more likely to consume alcohol (P = 0.005), had more severe stenosis (CT median: 80% vs. 72%; P = 0.005; MRI median: 79% vs. 72%; P = 0.01), lower American Heart Association grade (P = 0.03), and more frequent lipid plaque (89.8% vs. 76.4%; P = 0.04) compared to patients with asymptomatic stable plaques. Stenosis severity (odds ratio [OR], 1.037; 95% CI, 1.015-1.059) and additionally alcohol consumption (OR, 3.571; 95% CI, 1.694-7.527) were found to be the only significant predictors of a recent stroke.

In this cohort, no IPH or other plaque characteristics were associated with stroke risk. The degree of stenosis and alcohol consumption were the only factors associated with ipsilateral stroke. Larger prospective studies considering plaque characteristics are needed.